One of the most persistent blind spots I see in workforce health data is that some of the highest-risk employees often look perfectly healthy on paper. Their absence records may be unremarkable. Their health assessments may not trigger concern. Yet behind the scenes, they are juggling ageing parents, dependent children, financial pressures and a constant stream of competing demands that rarely make it into a risk dashboard.
This is the caregiver penalty, and it deserves far more attention than it currently receives. Not because it is a wellbeing issue in the traditional sense, but because it is a measurable workforce risk with implications for productivity, retention, absence, health outcomes and governance. The challenge for employers is that sandwich-generation stress rarely presents as a single condition. Instead, it accumulates quietly, distorting workforce health profiles long before it appears in formal sickness data.
The Hidden Risk Profile
Too many organisations still treat caring responsibilities as a personal circumstance rather than a business risk factor. That is a mistake.
The sandwich generation sits at the point where unpaid care and paid employment collide. Employees may be supporting elderly relatives while simultaneously raising children, managing household finances and maintaining demanding careers. The result is a sustained level of strain that is often invisible to conventional workforce health programmes.
The evidence is increasingly difficult to ignore. The Chartered Institute of Personnel and Development (CIPD, 2024) notes that caring responsibilities can be physically, psychologically, emotionally and financially demanding, and that combining care with paid work can intensify those pressures. Meanwhile, Office for National Statistics (ONS, 2024) analysis of unpaid carers demonstrates a clear association between unpaid caring responsibilities and health outcomes.
From a workforce perspective, that matters because it means a significant proportion of employees who appear healthy according to standard metrics may already be carrying a substantial and largely unrecognised burden. In my experience, this is where many organisations underestimate exposure. They focus on diagnosed conditions while overlooking the life circumstances that often drive future health deterioration.
Why Most Health Risk Scores Miss the Signal
Most workforce health risk models rely on data that employers can easily collect and quantify. Age, gender, body mass index, smoking status, declared medical conditions, absence records and wellbeing survey results all have their place.
The problem is that caring-related stress does not fit neatly into those categories.
An employee managing significant caring responsibilities may present as low risk across traditional indicators while simultaneously experiencing chronic sleep disruption, heightened stress, reduced recovery time and increasing presenteeism. The data looks reassuring, but the reality is more complex.
This is where the Health and Safety Executive’s (HSE, 2024) stress management framework offers a useful lens. The HSE identifies six key areas that influence work-related stress: demands, control, support, relationships, role and change.
Sandwich-generation stress intersects with all six.
Work demands become harder to manage when caregiving responsibilities create competing priorities. Control diminishes when emergencies arise outside working hours. Support becomes critical. Role clarity can suffer when employees are constantly switching between family and professional obligations. Organisational change, particularly when poorly managed, can become the tipping point that pushes an already stretched employee beyond capacity.
That does not mean traditional health risk scores are wrong. It means they are incomplete. They measure what is visible while often missing what is predictive.
The Business Cost of Looking the Other Way
The commercial consequences are neither theoretical nor insignificant.
CIPD (2024) reports that a quarter of working carers in the UK were considering leaving their jobs entirely because of the difficulty of combining work and caring responsibilities. For employers, that represents a direct retention risk with associated costs in recruitment, onboarding, lost productivity and institutional knowledge.
The financial dimension is equally important. According to Carers UK’s State of Caring 2024 report, 61% of unpaid carers were worried about living costs and their future financial security, while 51% said their financial situation was negatively affecting their mental health.
This is where the caregiver penalty becomes particularly expensive.
Stress rarely exists in isolation. Financial anxiety compounds caring pressures. Poor sleep increases fatigue. Fatigue increases the likelihood of mistakes. Over time, productivity declines, engagement weakens and health outcomes deteriorate.
What I see repeatedly is organisations attempting to tackle these issues as separate problems. Financial wellbeing sits in one programme. Mental health support sits in another. Flexible working sits somewhere else entirely. Employees, however, experience these pressures simultaneously. The risk is cumulative, not compartmentalised.
When leaders assess workforce health risk, they should be evaluating the interaction between caregiving responsibilities, financial strain and managerial support—not simply reviewing absence statistics.
Where Senior Leaders Should Be Looking
The earliest signs rarely appear in health claims data.
HR teams often notice the pattern first. A previously dependable employee becomes difficult to schedule. Participation in projects, travel or development opportunities starts to decline. Managers begin making informal adjustments to accommodate individual circumstances.
Finance leaders encounter the issue differently. They see productivity leakage, increased replacement costs and growing operational complexity as teams attempt to cover gaps.
Risk leaders face another challenge altogether. Concentrated expertise, key-person dependency and workforce resilience can all be affected when a significant portion of skilled employees are managing substantial caring responsibilities outside work.
There is also an important governance dimension.
The HSE (2024) makes clear that employers have a legal duty to assess risks to health arising from work-related stress. Acas (2025) similarly states that employers must undertake risk assessments to protect employees from stress at work.
If a sizeable proportion of your workforce is likely to be balancing employment with unpaid caring responsibilities, yet your risk framework does not account for that reality, there is a strong argument that your understanding of workforce exposure is incomplete.
What Better Practice Looks Like
The solution is not greater surveillance or intrusive data collection. The goal should be more intelligent risk identification and management.
I would focus on five priorities.
First, bring caring responsibilities into routine workforce risk conversations rather than limiting them to occasional wellbeing surveys. Managers, occupational health teams and HR professionals should be equipped to discuss these issues appropriately and confidentially.
Second, segment workforce risk by life stage and caring burden. Generic wellbeing scores often conceal meaningful differences in risk exposure. Patterns such as repeated short-notice leave, schedule disruption, declining engagement and stress-related concerns can reveal far more than headline scores.
Third, treat flexibility as a risk-control mechanism rather than an employee perk. CIPD’s guidance on carer-friendly workplaces highlights flexible working arrangements, leave provisions and peer support as practical interventions that help employees remain productive and engaged.
Fourth, strengthen manager capability. The HSE emphasises early intervention and individual action plans where stress risks emerge. Skilled managers are often the difference between a temporary pressure point and a prolonged absence.
Fifth, use workforce analytics to understand whether carers are experiencing disproportionately poor outcomes. If carers are leaving more frequently, progressing more slowly, recording higher absence levels or reporting lower engagement, the issue is structural and deserves a strategic response.
The Strategic Question Leaders Need to Ask
The caregiver penalty is not a soft-welfare issue. It is a workforce risk that conventional health scoring systems frequently underestimate.
Organisations that manage this challenge effectively will move beyond broad wellbeing narratives and start treating caring responsibilities as a measurable factor in stress, productivity, absence and retention risk. They will recognise that some of the most important workforce health indicators are not medical at all; they are behavioural, operational and contextual.
The question for senior leaders is straightforward. Are you confident that your current workforce risk model can identify caregiver-related strain before it appears as sickness absence, attrition or performance decline? If the answer is no, the next health risk sitting on your dashboard may already be there—you simply have not labelled it correctly yet.